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HomeMy WebLinkAboutUS SURVEY 3201 LT 22 T10N R1W SEC 9Mark Begich Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: o4ao Llcs Date of Issue: Legal Description U 3749t L 2z (±c°j ' zo. c.), Pump Installation Date: G - ._iS Pump Intake Depth Below Top of Well Casing:$0 feet Pump Manufacturer's Name: Re '3146•1:2T- Pump 314rks'!"Pump Model: 50 C 9 I t Pump Size 1/, hp Pitless Adapter Burial Depth: / 0 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: ✓ Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Comments: cWoe; tot. P2Iti7"S Property Owner Name & Address: 5'WPM MRaft 19B t.,, err t t 1 RD 1310 Ctf'tK 4345410 Pump Installer Name: AYIChO€ t WT‘td-Qk nfSte Vic E, Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. CHEMICAL & Gtn_AJOGICAL LABORATORIES ALASKA, INC. TELEPHONE (907)-279.4014 274-3364 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: t} Water System Name (P,/ X. {e F.0 Gr.� Mailing Acidress City - I.D NO. Phone No. SAMPLE DATE: Mo. Day State Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref no 1 O Special Purpose SAMPLE NO. LOCATION 1 1 .>. _._ v 2 ` _, Let.,.)%.,r J,f. .., J(e„_ Zip Code -' 0 Untreated Water 3 1 4 1 5 1 Time Collected Collected By TO. BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: b, Satisfactory O Unsatisfactory O Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical. Method: O Fermentation Tube • Membrane Filter Lab Ref. No. Result' Analyst - +Noof colonies/100 ml. or No. of Positive portions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 0e-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Time Received a.m. p m Lab No Presumptive 10m1 l0m1 10mI 10mI 10m1 1.Om1 0.1m1 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Multiple Tube Report Membrane Filter: Direct Count Broth 24 hours: Broth 48 hours: 10m1 Tub s Positive/Total 10m1 Portions Colltorm/100m1 Verlflcatlon• LTB - BGB Final Membrane Filter Res9lts- Reported By Date Time• Coliform/100m1 am p.m. INSPECTION APPOINTMENT �/ DATE RECEIVED TIME TIME c ilA f U , TIME DATE DATE 1-2.-� m‘ -y-\ DATE u-a-S,o " 6210s -/•/e INSPECTOR INSPECT ays4 INSPECTOR ip 171 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF I-i:ALTH & OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL P,OTECTION 825 L Street - Anchorage, Alaska 99501 I'1 r\FR 1 1980 SANITATION DIVISION Telephone 264-4720 RR 'AWED OF INDIVIDUAL WATER AND SEWER FACTgif it _t(q ENVIRONMENTAL REQUEST FOR APPROVAL DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing. 1. PROPERTY�t/R JJ PHONE 7 .74:),/6s3- - MAILING ADDRESSCY 71 ICE 9 PROPERTY RESIDENT (If different from above) / PHONE 2. BUYER Va/fantf A /lie/ PHONE %70/ ic- 3 � MAILING AD/DRdSy©/ T /30c `/OJ%wcd13. LENDI G I TITUTION %(7 rt`A 1y/s /dc-iioka/ Jamie e9/Me PHONE MAILING ADDRESS 4. REALTOR/AGENT -. PHONE MAILING ADDRESS 5. LEGAL/DESCRIPTION \ o 01-c72- a. 5 Sc;v--vey 3 2-0/ ( &i` Ge -e ) STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF‘BEDROOMS • One ❑ Four IM Other 017 SINGLE FAMILY IN Two ❑ Five • MULTIPLE FAMILY ❑ Three Six 7. WATER SUPPLY I1' INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ■ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 0--- INDIVIDUAL/ON-SITE** /929' YEAR ON-SITE SYSTEM WAS INSTALLED. IN PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1 72-010 (Rev. 6/79) 4) r �lsrzet 1, C6 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE • SINGLE FAMILY • MULTIPLE FAMILY NUMBER OF BEDROOMS IN ONE ■ THREE ■ FIVE • OTHER IN TWO ■ FOUR IN SIX 2. WATER SUPPLY • INDIVIDUAL ■ COMMUNITY O PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ElINDIVIDUAL/ON -SITE ■PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER IN Septic Tank or ■ Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 12,a at—XL— / Yw c ry (ixo • O`er a° �^ ^' rj _ �i COi�.[ ,^^!-4'A� �Pppr`lndSVG L/ . f+Ft�� 44.../ '-44.41:4 `N_.� t' s . .0.n.-- ("Wisz°A,(.4 /may/1 gaPL. ♦11 (—...0-.1....-\Aa.'r�cf+ [{Y4 t-tg fi ,. 'r444 t124,W1 /Mal , 0(a 0 ,4, - --12 ,4614, �,rl,_,r..4?... A4,142,04A.ALI—diS>r /.vY14 "). L F:.4 [b----- PROVEDFOR 6 BEDROOM CO CONDITIONAL APPROVAL (le r must c pppmpany c rtificate) 'f--- DI APPROVED A, J / '' DATE t� — _ • O �. ,,,Tp) BY v.4'' PC �� 72-010 (Rev. 6/79)